Title | The Role of Extent of Resection in IDH1 Wild-Type or Mutant Low-Grade Gliomas. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | Patel T, Bander ED, Venn RA, Powell T, Cederquist GYoung-Min, Schaefer PM, Puchi LA, Akhmerov A, Ogilvie S, Reiner AS, Moussazadeh N, Tabar V |
Journal | Neurosurgery |
Volume | 82 |
Issue | 6 |
Pagination | 808-814 |
Date Published | 2018 06 01 |
ISSN | 1524-4040 |
Keywords | Adult, Aged, Brain Neoplasms, Cohort Studies, Female, Glioma, Humans, Isocitrate Dehydrogenase, Middle Aged, Mutation, Neoplasm, Residual, Neurosurgical Procedures, Proportional Hazards Models, Retrospective Studies, Treatment Outcome |
Abstract | BACKGROUND: Maximizing extent of resection (EOR) improves outcomes in adults with World Health Organization (WHO) grade II low-grade gliomas (LGG). However, recent studies demonstrate that LGGs bearing a mutation in the isocitrate dehydrogenase 1 (IDH1) gene are a distinct molecular and clinical entity. It remains unclear whether maximizing EOR confers an equivalent clinical benefit in IDH mutated (mtIDH) and IDH wild-type (wtIDH) LGGs. OBJECTIVE: To assess the impact of EOR on malignant progression-free survival (MPFS) and overall survival (OS) in mtIDH and wtIDH LGGs. METHODS: We performed a retrospective review of 74 patients with WHO grade II gliomas and known IDH mutational status undergoing resection at a single institution. EOR was assessed with quantitative 3-dimensional volumetric analysis. The effect of predictor variables on MPFS and OS was analyzed with Cox regression models and the Kaplan-Meier method. RESULTS: Fifty-two (70%) mtIDH patients and 22 (30%) wtIDH patients were included. Median preoperative tumor volume was 37.4 cm3; median EOR of 57.6% was achieved. Univariate Cox regression analysis confirmed EOR as a prognostic factor for the entire cohort. However, stratifying by IDH status demonstrates that greater EOR independently prolonged MPFS and OS for wtIDH patients (hazard ratio [HR] = 0.002 [95% confidence interval {CI} 0.000-0.074] and HR = 0.001 [95% CI 0.00-0.108], respectively), but not for mtIDH patients (HR = 0.84 [95% CI 0.17-4.13] and HR = 2.99 [95% CI 0.15-61.66], respectively). CONCLUSION: Increasing EOR confers oncologic and survival benefits in IDH1 wtLGGs, but the impact on IDH1 mtLGGs requires further study. |
DOI | 10.1093/neuros/nyx265 |
Alternate Journal | Neurosurgery |
PubMed ID | 28945860 |
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